Admission source, which is determined by the healthcare setting that was utilized 14 days prior to home health admission, will affect reimbursement. Each 30-day period is classified into one of two admission source categories – community or institutional. Patients coming from the community will have a lower reimbursement amount for the payment period than patients coming from an institutional setting.
Home health organizations newly enrolled in Medicare on or after January 1, 2019 will not receive split percentage payments.
Home health organizations enrolled prior to January 1, 2019 will continue to receive split percentage payments until 2020.
With PDGM, it is critical that an accurate assessment is performed to demonstrate functional ability for correct scoring on the OASIS. Secondary diagnoses should also be properly documented as comorbidities can increase reimbursement up to 20 percent.
Documentation at the point of care will be essential with the new 30-day periods. Electronic Health Records (EHR) will facilitate getting paid faster and streamlining operations.